A 73-year-old female presented with decreased visual acuity of her left eye that lasted for a month. The patient was systemically healthy and did not report a history of diabetes or hypertension. Her best-corrected visual acuity was 20/20 in the right eye and counting fingers at 30 cm in the left eye. The intraocular pressure was 14 mmHg in the right eye and 13 mmHg in the left eye. Slit-lamp examination showed numerous mutton-fat keratic precipitates, 2+ anterior chamber cells, moderate cortical and nuclear sclerosis cataract, and fibrinous membrane bridging the pupil, with 360 degrees of posterior synechiae. Fundus examination revealed prominent vitreous haze along with yellow-white infiltrates near the foveal center. The SD-OCT demonstrated hyperreflectivity of the intraretinal layers with disorganization of retinal structure and retinal pigment epithelium (RPE) elevation. Moreover, remarkably thickened choroid beneath the active lesion with hyporeflectivity of the choroid was also noted. Wide-field fluorescein angiography showed hyperfluorescence of the active lesion and leakage of dye from the optic disc. Findings in the right eye were nonspecific with the exception of mild cataract. The patient indicated consumption of raw pork prior to her current illness. On laboratory examination, the titer of serum IgG antibodies against Toxoplasma gondii was found to be > 650.0 IU/ml (normal < 1.0 IU/ml) and titer of serum IgG antibodies against Toxocara canis was 2.062 (normal < 1.140). Based on the clinical features and laboratory findings, a diagnosis of ocular toxoplasmosis of the left eye was made. The patient was treated with oral Bactrim (80 mg trimethoprim + 400 mg sulfamethoxazole) 2 tablets twice daily, oral prednisolone 50 mg daily, topical prednisolone acetate 1.0% (Pred-forte®) every 2 h, and 2.0% homatropine twice daily. After 4 weeks, slit-lamp examination showed reduced inflammatory reaction in the anterior chamber. The grade of anterior chamber cells decreased to 1+ and posterior synechiae were broken. The dose of oral prednisolone was tapered gradually over 4 weeks while the course of oral Bactrim was continued. Fundus examination revealed decrease in vitreous opacities; however, the yellow-white infiltrates persisted near the foveal center. The SS-OCT-A device (PLEX Elite 9000; Carl Zeiss Meditec, Inc., Dublin, CA) was used to evaluate the morphological characteristics of the active lesions. Structural en face SS-OCT imaging at the level of the choroid 150 μm below the RPE revealed hyporeflectivity of the macular lesion with diffuse choroidal dilation and many collateral vascular branches surrounding the lesion, which is more remarkable in magnified image (indicated by Box 1). SS-OCT-A image at a level deeper to choriocapillaris demonstrated congested choroidal vasculature. The SS-OCT B-scan showed disruption of the neurosensory retinal layers with interruption of the photoreceptor inner and outer segment junction and RPE elevation. Multiple hyperreflective dots in the vitreous cavity indicating severe vitritis and dilated Haller’s layer vessels were also noted. The choroid beneath the lesions remained thick and hyporefective; however, a decrease in the thickness was observed when compared to the thickness recorded in the first visit. Due to the proximity of the lesion to the macula area, the decision to combine intravitreal injections with systemic antibiotic therapy was made. Therefore, two intravitreal injections of clindamycin (1 mg/0.1 ml) were administered at weekly intervals, along with systemic antibiotics and corticosteroids. Follow up after two weeks revealed diminished vitreous opacity and reduction in the size of the macular lesion with more discrete margins. Thinning of the hyperreflective lesion of the intraretinal layers and further reduction in the choroidal thickness was observed. Subsequently, the patient was administered six additional intravitreal injections of clindamycin (1 mg/0.1 ml) at an interval of 1 to 2 weeks. Oral Bactrim was discontinued after 8 weeks and the dose of oral prednisolone was tapered gradually over the next four months. Four months after the first visit, the best-corrected visual acuity of the patient was 20/125 and the intraocular pressure was 15 mmHg in the left eye. Slit-lamp examination showed trace anterior chamber cells with the absence of keratic precipitates. Fundus examination revealed presence of an atrophic scar in the macular area. Structural en face SS-OCT imaging demonstrated normalization of congested and dilated choroidal vessels, which is more remarkable in magnified images (indicated by Box 2). Marked constriction of the collateral vascular branches around the chorioretinal scar was observed. SS-OCT-A image revealed that the choroidal vasculature are visible within the atrophic macular lesion. The SS-OCT B-scan showed thinning and disorganization of the neurosensory retina with the presence of overlying thickened posterior hyaloid. The thickness of the choroid beneath the lesions decreased to a level below the normal value. The choriocapillaries, Sattler’s layer, and Haller’s layer disappeared partially and became hyperreflective. At the final follow up, 9 months after the first visit, only topical prednisolone acetate 1.0% was being continued and the patient had no recurrence of the condition.